ABSTRACT
Background: Pulmonary fibrosis persists long after recovering from coronavirus disease 2019 (COVID-19) infection, thereby reducing quality of life and lung function. We aimed to evaluate the prevalence and risk factors for pulmonary fibrosis in patients with severe COVID-19 pneumonia requiring mechanical ventilation, a high-risk group for developing pulmonary fibrosis. Methods: Clinical data and chest computed tomography (CT) scans of patients with severe COVID-19 pneumonia requiring mechanical ventilation were retrospectively collected from nine hospitals in South Korea. Fibrotic-like changes on chest CT were visually assessed. Results: We included 125 patients with a mean age of 68.5 years, 60.8% men and 7.2% having underlying lung disease. Based on follow-up chest CT (the median interval: 38.0 days, interquartile range: 24.0–68.0 days), 94 (75.2%) patients exhibited fibrotic-like changes, with traction bronchiectasis and/or bronchiolectasis being the most common change (60.8%). Adjusted Cox regression analysis revealed as association between hemoglobin levels ≤9 g/dL and an increased risk of pulmonary fibrosis development (HR: 3.182, 95% Cl: 1.203–8.415, P=0.025). Among all patients, 17.6% died during hospitalization and 71.2% experienced complications, including intubation-related airway injury (12.8%), ventilator-associated pneumonia (44.8%), lung injury (11.2%), and hemodynamic disturbance (33.4%). In-hospital mortality (16.1% vs. 18.1%) and complications (67.7% vs. 72.3%) were similar between patients with and without fibrotic-like changes. Conclusion: Our study demonstrated that in patients with severe COVID-19 pneumonia requiring mechanical ventilation, chest CT revealed fibrotic-like changes in approximately three-fourths of patients. Low hemoglobin levels might be associated with pulmonary fibrosis in severe COVID-19 pneumonia.
Subject(s)
Lung Diseases , Pneumonia , Critical Illness , COVID-19 , Pulmonary FibrosisABSTRACT
Backgrounds : The management of lung complications, especially fibrosis, after coronavirus disease (COVID-19) pneumonia, is an important issue in the COVID-19 post-pandemic era. We aimed to investigate risk factors for pulmonary fibrosis development in patients with severe COVID-19 pneumonia.Methods Clinical and radiologic data were prospectively collected from 64 patients who required mechanical ventilation due to COVID-19 pneumonia and were enrolled from eight hospitals in South Korea. Fibrotic changes on chest computed tomography (CT) was evaluated by visual assessment, and extent of fibrosis (mixed disease score) was measured using automatic quantification system.Results Sixty-four patients were enrolled, and their mean age was 58.2 years (64.1% were males). On chest CT (median interval: 60 days [interquartile range, IQR; 41–78 days] from enrolment), 35 (54.7%) patients showed ≥ 3 fibrotic lesions. The most frequent fibrotic change was traction bronchiectasis (47 patients, 73.4%). Median extent of fibrosis measured by automatic quantification was 10.6% (IQR, 3.8–40.7%). In a multivariable Cox proportional hazard model, which included nine variables with a p-value of < 0.10 in an unadjusted analysis as well as age, sex, and body mass index, male sex (hazard ratio [HR], 3.01; 95% confidence interval [CI], 1.27–7.11) and higher initial sequential organ failure assessment (SOFA) score (HR, 1.18; 95% CI, 1.02–1.37) were independently associated with pulmonary fibrosis (≥ 3 fibrotic lesions).Conclusion Our data suggests that male gender and higher SOFA score at intensive care unit admission were associated with pulmonary fibrosis in patients with severe COVID-19 pneumonia requiring mechanical ventilation.